Peer-reviewed article
Implementation and effects of social protection programs for children, older adults, and people with disabilities in Brazil and Ecuador: A scoping review.
Pescarini JM, Moncayo AL, Guimarães JMN, Dias FS, Ruiz R et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This scoping review examined seven social protection programs in Brazil and Ecuador to understand their effects on health and socioeconomic conditions for children, adolescents, older adults, and people with disabilities. The review analysed 114 studies, mostly focusing on Brazil's Bolsa Família program. The evidence shows some positive planned effects on children's health in Brazil, but significant gaps remain, particularly regarding unintended consequences, effects on adults and caregivers, and programs targeting older adults and people with disabilities in both countries.
Key points
- In Brazil, substantial evidence exists for Bolsa Família's planned effects on children's health and some socioeconomic determinants, but little evidence on unplanned effects in adults and caregivers
- Evidence for Brazil's Beneficio de Prestacao Continuada on health outcomes was scarce, with only one study in older adults and none among people with disabilities
- In Ecuador, evidence was found only for the Bono de Desarrollo Humano, with limited studies on planned health effects and few on socioeconomic determinants and unplanned effects
- Most studies lacked longitudinal data, quasi-experimental designs, or comparison groups of eligible non-recipients, limiting causal inference
- Large variations in coverage and implementation of programs were observed across both countries
Limitations
The review could not evaluate five of the seven programs due to absence of studies, limiting understanding of their actual impacts. The methodological limitations of included studies (mostly lacking rigorous designs and longitudinal data) restrict the ability to draw firm conclusions about program effectiveness.
Abstract
We conducted a scoping review to investigate planned (intentional) and unplanned (not intentional) effects of social protection on socioeconomic determinants of health (SDH) and health inequalities among children, adolescents, elders and people with disabilities, and their caregivers. We reviewed seven programs in (i) Brazil (Programa Bolsa Familia (BFP) and Beneficio de Prestacao Continuada (BPC)), and (ii) Ecuador (Bono de Desarrolo Humano (BDH), Bono 1000 días, Pensión Mis Mejores Años/Pensión para Adultos Mayores, Pensión Toda una Vida/Pensión para personas con discapacidad and Bono Joaquín Gallegos Lara). We searched PubMed, EMBASE, LILACS, Scopus, Econlit, PsycINFO, Global Health, Global Index Medicus and grey literature for studies evaluating program implementation and effects on health outcomes or SDH from 1990 to 2023. We extracted data from 114 studies (84 on BFP, 17 on BDH and 13 on BPC). No studies were identified for the remaining programs. In Brazil, we found substantial evidence of BFP planned effects on children's health and some SDH but little evidence on its unplanned effects in adults and caregivers. Evidence effects of BPC on health outcomes were scarce, with only one study in elders and none among people with disabilities. In Ecuador, we found evidence only for BDH, with some studies on planned health effects and few on SDH and its unplanned effects. Very few studies used longitudinal data, quasi-experimental designs, or comparison groups of eligible non-recipients. Finally, we found large variations coverage and implementation of programs. In summary, our review highlights the lack of evidence on the overall impacts of social protection in Ecuador, particularly those targeting older adults and people with disabilities. In Brazil, further research is needed on unplanned health effects of the BFP and on the impacts of social protection targeting elders and people with disabilities.